Association of drug therapy with the risk of incident frailty: a systematic review.

Medication is a potential factor influencing frailty. However, the relationship between pharmaceutical treatments and frailty remains unclear. Therefore, we conducted the present systematic review to summarize the association between drug therapy and the risk of incident frailty in older adults. We systematically searched the MEDLINE electronic database for articles indexed between January 1, 2000, and December 31, 2021, for randomized controlled trials (RCTs) and cohort studies reporting frailty changes associated with drug therapy. A total of 6 RCTs and 13 cohort studies involving 211,948 participants were identified, and their treatments were categorized into six medication classes: analgesics, cardiometabolic medication, chemotherapy, central nervous system (CNS)-active medication, hormonal therapy, and nutritional supplements. While the analysis revealed that only CNS-active medications were associated with an elevated risk of frailty, other medication classes also affected frailty; however, this is not conclusively attributable to a class-wide effect.

Change in a Claims-Based Frailty Index, Mortality, and Health Care Costs in Medicare Beneficiaries.

BACKGROUND: A claims-based frailty index (CFI) allows measurement of frailty on a population scale. Our objective was to examine the association of changes in CFI over 12 months with mortality and Medicare costs. METHODS: We used a 5% sample of fee-for-service Medicare beneficiaries. We estimated CFI (range: 0­1: nonfrail (<0.25), mildly frail (0.25­0.34), moderately-to-severely frail (≥0.35) on January 1, 2015 and January 1, 2016. Beneficiaries were categorized as having a large decrease (-<0.045), small decrease (-≤0.045-0.015), stable (±0.015), small increase (>0.015-0.045), or large increase (>0.045). We used Cox proportional hazards model to estimate hazard ratio (HR) for mortality adjusting for age, sex, and 2015 CFI value and compared total Medicare costs from January 1, 2016 to December 31, 2016. RESULTS: The study population included 995 664 beneficiaries (mean age 77 years, 56.8% female). In nonfrail (n = 906 046), HR (95% confidence interval [CI]) ranged from 0.71 (0.67-0.75) for a large decrease to 2.75 (2.68-2.33) for a large increase. In moderate-to-severely frail beneficiaries (n = 16 527), the corresponding HR (95% CI) ranged from 0.63 (0.57-0.70) to 1.21 (1.06-1.38). The mean total Medicare cost per member per year (standard deviation) was from $12 149 ($83 508) in nonfrail beneficiaries to $61 155 ($345 904) in moderate-to-severely frail beneficiaries. CONCLUSIONS: One-year changes in CFI are associated with elevated mortality risk and health care costs across all levels of frailty.